Financial report of an authorized party authority. ,77,17/Al / 1. Number of contributors:

Transcription

1 DO LE DIRECIEUR GÉNÉRAL DES ÉLECTIONS DU QUÉBEC. DGE-2 O-VA (4-0) Financial report of an authorized party authority Income statement of an authorized party authority IDENTIFICATION Party and electoral division/region Official representative Pedod REVENUES Contributions (Schedule 3) Membershlp (membership cards) Revenues from political activities (Schedule, total A) Subsidiary revenues (Schedule, total B) Reimbursement of election expenses by the DGE Transfers from the party Transfers from another authority Transfers from official agents lnterest earned 7 e,e,i -c.e4i b. Other revenues (specify),77,7/al / Number of contributors: /9e.es,ti,ce- 7 a ee ieqe /c. 234 eykez 9 REVENUES (fine to 8) e5$ 79 9' Year Month Day From' 7...*/ e/ i I To 20/ /i /2 g/ I Remark: lt is recommended that the official representative make a copy of this report' before sending it to the Chief Electoral I

2 Party and electoral divislon/reglon 4ssoeed7,- ew 2'4t 2:9p, EXPENSES Interest on bans (Schedule 2, total F) Advance reimbursement of the surplus to the DGE Transfers to the party Transfers to another authority Transfers ta official agents Expenses of activities Election expenses attributable to official agents Fees to participate in statutory meetings (meals, transport, etc.) Secretariat and office expenses Publicity Rent et; pee al g A-0-e 4e) 3 Telecommunications Non-compliant contributions of a past year reimbursed to the DGE Service and administration expenses Other expenses (specify) FemiDeedipepv4 evieere EXPENSES (Une 20 to 4) SURPLUS OF REVENUES (EXPENSES) OVER EXPENSES (REVENUES) (line 9 42) NET ASSETS AT THE START OF THE PERIOD (bine 45 of the report of the previous period) 7, 2 2 cii ( ee 4 /0, te] 45 NET ASSETS AT THE END OF THE PERIOD (line ) ezi$

3 Balance sheet of an authorized party authority IDENTIFICATION Party and electoral division/region Official representative /) 'eeeeee//ep,f( e/yeelier - eeki4e vb#,/ e e./zeeee.e. ASSETS Cash on hand 2 Petty cash 3 Investments (Schedule 5.0, total C) 4 Reimbursement of election expenses ta be received from the DGE 5 Transfers ta be received from the party 6 Transfers to be received from another authority 7 Election expenses attributable to official agents to be received 8 Other sums ta be recelved 9 Loans to the party (Schedule 5., total FI 0 Loans ta another authority (Schedule 5.2, total I) Furniture and equipment 2 Computer equipment 3 Other fixed assets 4 Other assets (specify) 5 ASSETS (line ta 4) LIABILITIES g 9. 93z Year Monh Dey On leilfei /t Cash on hand deficiency Accounts-payable Transfers to be paid ta the party Transfers ta be paid to another authority Surplus advance to be paid ta the DGE Other sums payable Deferred revenues Loans from financial institutions or electors (Schedule 2.0, total E) Loans fram the party (Schedule 2., total I) Loans from another authority (Schedule 2.2, total L) Other liabilities (specify) LIABILITIES (une 6 ta 26) NET ASSETS 28 Net assets (Une 6-27) (Must correspond ta line 45 of the incarne statement) 29 NET LIABILITIES AND ASSETS (une ) Deolaration of the official representative I state that ail of the information given in this report is true, accurate and complete. 47G t 49-rs zzi

4 Reconciliation of the cash on hand of an authorized party authority IDENTIFICATION Party and electoral division/region Official repreeentative Period #, '5''ee eber7le el efee- ie-.y,,,i4e- D/b4,tpree) -N-ee/ed 4 Aie SV /Cre.-- Year Month Day Fromiepelli DI I dl e I To VO/ 9 /e l el Cash on hand (overdraft) at the end of the previous period Plus : 2 Revenues of the current period (line 9, income statement) e9: 06e Minus: 3 Expenses of the current period (line 42, income statement) 4Subtotal (fine +2-3) Plus : 5 Petty cash at the end of the previous period 6 Amounts receivable and other assets at the end of the previous period 7 Value of the assets disposed of during the period 8 Increases of bans during the period (Schedule 2, total C+G+J) 9 Disposals of investments during the period (Schedule 5, total B) 0 Sums recovered on bans du ring the period (Schedule 5, total E+H) Amounts payable and other Habilites at the end of the period (une 7 to , balance sheet) Less: Petty cash at the end of the Period (line 2, balance sheet) Amounts recelvable and other assets at the end of the period (lino 4 to B + 4, balance sheet) Value of the assets acquired during the period Repayments of bans during the period (Schedulè 2, total D+H+K) Acquisitions of investments during the period (Schedule 5, total A) Loans granted during the period (Schedule 5, total D+G) tere.2 73z. t 8 9 Amounts payable and other liabilities at the end of the previous period Cash on hand (overdraft) at the end of the current period (line toll 2 to.8) (Must correspond to line or 6 of the balance sheet) / lez

5 mftyeeile 5 4"/ 477o itafee beo,êfeeve.)) edule - Sums collected during funding activies or political activities Date Location Nature Admission fee - ' as a contribution revenue Sums collected as a political activity revenue Subsidlary revenues D SUMS must be part of the amount of the contributions to be entered on fine of the ne statement adule 2- Loans From a financial institution or an elector.. r0.. an # Sumame, given name and address of lender Date of the ban lnterest rate Opening balance Amount borrowed during the period Amount reimbursed during the period Closing balance Interest paid during the period From the party Name of the party From another authority Name of the authority II L Li In 7 j.j/, ;,---'.. --il pi es w 2,/,,,, 4, : //// //4.'/ r ' / /, ;"

6 Authodtv - l'-7-54e> 47-etm/ Lee242É-.beozeF-4),é'i) Schedule 4- Suretyships Sumame and given name of the eiector Domicillary address (No., street, apartment, clty and postal code) Amount stood suréty for. Schedule 5- Investments and bans 5.0 Investments Name of the institution Balance at the start of the petiod Acquisitions (additions) Disposais (reductions) e,g>et)4 led-s fe- 7y4elie Balance at the end of the period I 794e/ tee Ve. lei 5. Loans to the party Name of the party ' Le jfi 5.2 Loans to another authority Name of the authority I Li

7 Aueb3etY,e.5 e./4,774 9,e ceà5,- 44f4 e Schedule 6- Financial institution where the sums collected are deposited Name of the institution Address of the institution Account no. Schedule 7- Contributions of goods and services Surname and given name of the elector (alphabetical order) Domiciliny address ' (No., street, aparbnent, clty and postal code) Number Amount I